Medicaid Supplemental Payments and Nursing Home Quality – a Case Study of Indiana

医疗补助补助金和疗养院质量 — 印第安纳州案例研究

基本信息

批准号：
9976249
负责人：
Hari Sharma
金额：
$ 4.95万
依托单位：
UNIVERSITY OF IOWA
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-04-01 至 2022-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9976249
关键词：
Medicaid Supplemental Payments Nursing Home

项目摘要

Project Summary: More than a million residents live in nursing homes in the United States at a cost of about 55 billion dollars to Medicaid. Nursing home quality has been a longstanding concern among policymakers. Adequate reimbursements are essential to improve quality in nursing homes. Although state and the federal governments jointly finance Medicaid, states have created various supplemental payment programs that rely on funds from the providers and local governments to finance the non-federal share. Supplemental payment program for nursing homes owned/operated by non-state governmental organizations (NSGOs) is one such program under which NSGOs contribute the state’s share of the supplemental payment to the state government through intergovernmental transfers. The state then claims federal matching dollars for the supplemental payment and transfers the supplemental payments to the NSGO-owned nursing home. Nursing homes and NSGOs share these funds based on their contract and nursing home expenditures. This program allows states to increase Medicaid reimbursement for NSGO-owned nursing homes without substantial burden on state budgets. Indiana offers a unique opportunity to study the effectiveness of the supplemental payment program to NSGO- owned/operated nursing homes because NSGOs bought/leased about 90% of nursing homes in Indiana during the past decade. In 2017, NSGO-owned nursing homes in Indiana received about 700 million in additional federal dollars under this program. Anecdotal newspaper articles suggest that NSGOs keep a large portion of the supplemental payments and that staffing has not improved in NSGO-owned nursing homes. Policymakers are increasingly concerned that NSGOs are using the supplemental payment program to boost their own revenues instead of helping improve the quality of nursing homes. Our objective is to evaluate the effectiveness of Indiana’s supplemental payments to NSGO-owned nursing homes in increasing nursing home revenue and expenditures and improving nursing home staffing and patient safety. To achieve this goal, we propose an econometric analysis for three specific aims: 1) To estimate the effect of supplemental payments to NSGO-owned facilities on nursing home revenue/expenditures, 2) To estimate the effect of supplemental payments to NSGO-owned facilities on direct care staffing (RN, LPN, and Nurse-aide); and 3) To estimate the effect of supplemental payments to NSGO-owned facilities on patient safety outcomes (pressure ulcers, infections, falls, and medication errors). Our results have the potential to affect CMS policies on states’ use of nursing home supplemental payment program by providing rigorous estimates on whether these payments had the intended effect of improving nursing home quality. Our results will provide empirical evidence for state and national policymakers on whether these programs represent efficient allocation of resources to improve nursing home quality.

项目概要：美国有超过百万居民住在疗养院，耗资约550亿美元医疗补助计划的质量一直是政策制定者长期关注的问题。尽管州政府和联邦政府都认为报销对于提高疗养院的质量至关重要。共同资助医疗补助，各州制定了各种补充支付计划，这些计划依赖于来自提供者和地方政府为非联邦份额的补充支付计划提供资金。由非国家政府组织 (NSGO) 拥有/经营的疗养院就是其中一项计划哪些 NSGO 通过以下方式向州政府缴纳州份额的补充付款然后，州政府要求联邦配套资金用于补充付款和将补充付款转给 NSGO 拥有的疗养院，并由 NSGO 分享。这些资金基于他们的合同和疗养院支出，该计划允许各州增加。对 NSGO 拥有的疗养院进行医疗补助报销，不会对州预算造成重大负担。印第安纳州提供了一个独特的机会来研究 NSGO 补充付款计划的有效性 - 拥有/经营疗养院，因为 NSGO 在 2017 年购买/租赁了印第安纳州约 90% 的疗养院 2017 年，印第安纳州 NSGO 旗下的疗养院额外收到了约 7 亿美元的资金。报纸上的轶事文章表明，NSGO 保留了该计划下的大部分联邦资金。 NSGO 拥有的疗养院的补充付款和人员配备没有改善。越来越担心 NSGO 正在利用补充支付计划来提高自己的水平我们的目标是评估疗养院的收入，而不是帮助提高疗养院的质量。印第安纳州向 NSGO 拥有的疗养院提供补充付款在增加疗养院方面的有效性收入和支出以及改善疗养院人员配备和患者安全为了实现这一目标，我们。提出针对三个具体目标的计量经济学分析： 1) 估计补充付款的影响 NSGO 拥有的设施对疗养院收入/支出的影响，2) 估计补充的影响向 NSGO 所属机构支付直接护理人员费用（RN、LPN 和护士助理）；以及 3) 估算向 NSGO 拥有的设施追加付款对患者安全结果（压疮、感染、跌倒和用药错误）。我们的结果有可能影响 CMS 关于各州使用药物的政策。疗养院补充付款计划，对这些付款是否已得到严格估计我们的结果将为国家和地区提供经验证据。国家政策制定者考虑这些计划是否代表了资源的有效分配以改善护理居家品质。